About a month and a half ago I came across a great article in the Chicago Tribune “Online with your Doctor” which discussed a lot of the issues facing medicine with regards to the difficulties the profession has had integrating the internet into private practices. A few themes emerged, that I think are important:

Patients want their docs to have a website

Patient privacy is paramount

Creating a website is hard and expensive

It would seem that issues two and three are so burdensome that they have made it seemingly impossible for medicine to embrace the internet in the same ways that say the travel, retail, food, banking, entertainment, or really every other industry that affects our daily lives have. This is why the healthcare industry needs a strong dose of creativity and reality in order to overcome their resistance to the internet. Before I touch on such a creative alternative, let me elaborate on the themes mentioned above.

Patients want their docs to have a website. The general population is use to being able to learn everything about a person, place or thing with a simple Google search. Why wouldn’t patients want to know more about their doctor’s credentials and training? Honestly, why wouldn’t doctors want to have this information easily accessible anyway? You walk into any doctor’s office and all of the degrees are posted prominently, might as well have a website that discloses the same information. And who wouldn’t want to have easy access to patient registration forms, insurance forms etc so that they could be filled out prior to an appointment? This is a win-win situation and it would seem the response would be an exponential increase in doctor’s embracing the internet with their own websites. However, the medical community has been very good at using the following excuse to slow progress:Patient privacy is paramount. I whole-heartedly agree, your health is between you and your doctor and the internet will not change that. I would argue as a society we are much more concerned with financial privacy than patient privacy. We have a lot more to lose if someone accesses our bank accounts than if someone were to access our health information. Excuse me for being blunt here, but honestly other than for the purposes of being nosy your health record is of little use to the public and definitely a lot less useful than your checking and savings account numbers and PIN. The point being that the banking industry has been a leader in internet security and has for the most part made the population comfortable with online banking, with the admittedly occasional breech in security, there is no reason why the healthcare industry cannot also become a partner in making the internet more secure. In my opinion the patient privacy issue is simply an excuse for the real problem: Creating a website is hard and expensive. I know this may be hard to believe for some of you that are more ingratiated in technology, but allow me to give some insight from the doctor’s perspective. The road to becoming a MD, as everyone is aware, is arduous. Four years of medical school, 3-10 yrs of additional training depending on the doctor’s desired specialty. Then once the journey of training is over, the six figure pay check is a reality and the young doctor tries to establish their practice in an economic environment they are ill prepared for. Not only does the doctor have the overhead associated with just the basics of starting a practice, there are the student loans which often times are in excess of $150,000 and the financial obligations we all incur once we reach late twenties or early thirties with regards to starting a family. Amongst all of this, the time and expense of creating a website is exorbitant especially if there is no obvious financial benefit.

This is where it becomes the job of leaders in the medical community to embrace rather than resist web technology and seek out simple alternatives so that patients are satisfied without creating further financial obligations for private practice doctors. In creating the idea for SavvyDoc we wanted to get rid of the excuse that it’s too hard and expensive to create, maintain and advertise a website for a single doctor or small group practice. By creating a website that makes it easy to upload picture, video and documents we have created a platform that provides patients with the information and insight into their doctor that they desire, without creating a financial hurdle. For medical professionals, resistance to the internet is futile, its time to embrace technology and provide patients with the type of care they are scouring the web for.

The Associated Pressreleased that Papa Johns has just crossed the threshold of over a billion dollars in orders from their online ordering system (including text message orders). Last year, their online sales topped $400 million, and they project the annual revenue from online orders to skyrocket over the next couple of years, as more people become more comfortable with the process. An interesting part in the press release was the mention of a Papa Johns franchise location that was extremely busy, yet very quiet, because they were receiving very little phone calls, and a majority of their orders were processed online.

As I mentioned in a post about some of the similarities between SavvyDoc and Potbelly’s, the Internet is really making it easier for us to process regular tasks. The benefis is the ability to operate at your own pace, and ultimately make more informed decisions because of the transparency. Is it that painful to order a pizza over the phone? Most likely not, but the added convenience online provided to the customer is important, especially if it will cut down on errors. We at SavvyDoc are trying to make doctors appointment scheduling as easy as ordering that pizza online. Imagine if you have five children, who have tons of activities, programs, and schedules, and instead of calling the dermatologist, orthodontist, and pediatrician, you could manage all of that from the comfort of your home, 24 hours a day, 7 days a week. If it works for pizza, it will work for an industry where 1 out of 3 people have an inability to make a timely appointment.

It would be disingenuous of us at SavvyDoc, to champion the need for further adoption of health care IT and not understand that with any new technology there will be unscrupulous providers of bad technology. I recently came across a great resource for doctors who are having issues with their electronic medical record systems or are looking to implement a system. Doctors in peril is a non-profit organization that is looking to help protect doctors from bad IT investments. There is some useful information on current companies the organization is fighting legal battles against, but there is also a brief breakdown on how to protect your IT investment, which is VERY good. For those of us looking to implement IT solutions into health care these bad technologies or bad companies only slow the progress of a blossoming field. Especially with SavvyDoc where we have created a solution particularly useful for smaller practices, which are at greater risk of these predatory selling practices, we want the buyer to make informed and smart decisions on IT solutions for their practice.

For those looking for faster adoption of IT in health care, Aetna is taking a nice step forward with their new plan to electronically alert doctors to patient care needs. Using Aetna’s claims information on patients the health insurer will be able to inform a doctor if a patient is allergic to a medication recently prescribed or if a patient is due for special tests. For example a patient with diabetes needs an annual exam with an ophthalmologist, when the Aetna system realizes an annual exam has been missed it will alert the patients PCP so that an appointment can be arranged. This is a great system, and its good to see the insurance companies leading the way with regards to implementing health care IT. Admittedly the system is not perfect, alerts will be made through a special physician website but physicians will also need to be notified via phone, fax or e-mail but even as currently constructed this is helping physicians to run a more efficient practice.

One of the issues that has come up recently with implementing technology into health care is the unrealistic desire that systems like the one Aetna has created, electronic medical records, Google Health, or SavvyDoc need to be perfect technologies. This can range from questions of integrating into other systems or questioning the usefulness of technologies simply from each specialists perspective. Each of these issues and others need to be covered by new technologies but this will happen in time and will require a period of trial and error. As the medical field is one of perfectionism, and rightly so, there tends to be resistance or a wait and see attitude for new technology. But even the most dangerous drugs, have to be tested on humans at some point and I believe we have reached this threshold with health care IT. Waiting for the perfect technology is a lot like waiting for the proverbial magic bullet cancer drug. Additions to the framework of already useful technology will make for an awesomely powerful IT solution but they are the icing on the cake and should not be viewed as barriers to implementation. When IT is able to adapt seamlessly to various specialties or patient situations and fully integrate across electronic medical records, billing software, appointment software, personal patient records etc. then the health care IT space will truly be mature and we at SavvyDoc will need to find another cause in health care to champion.

The Association of American Medical Colleges (AAMC) recently released a report on Industry Funding of Medical Education which was reported on by the New York Times this weekend. Unexpectedly, this was a very strong report seeking to ban all medical giveaways to medical school faculty, staff and students. Though this report is not a mandate, it is very likely that most if not all of the 129 U.S. medical schools will adopt the task force’s recommendations on how to proceed with medical school and private industry interactions. The report does a good job of realizing the role private industry plays in medical education and they are obviously not looking to prevent pharmaceutical or medical device companies from presenting to the medical school community (though its hard to believe these recommendations would not stifle these interactions). Rather the AAMC is concerned with the perceived conflict of interest when private industry presentations involve paying faculty to present information or presentations are attached to gifts such as free food and/or pens.

It is not a secret that the pharmaceutical and medical device companies spend billions of dollars marketing to doctors. However, unlike traditional marketing (TV and print adds for example) doctors receive free meals, pens (and other office products) as well as some more extravagant gifts. Considering there are slightly less than a million U.S. physicians but billions spent on marketing to them it’s not hard to imagine that some of these giveaways have been, lets just say, a little over-the-top. However, my initial reaction to the AAMC task force report is that it took the easy route by attempting to deal solely with the conflict of interest issues and missed an opportunity to create guidelines that would impact the real crux of the issue which is how private industry should market their products. We have all noted the influx of direct to consumer advertising by drug companies and my concern is that the position of the AAMC will only lead to more drug advertising through mainstream media. I point to the controversy surrounding this common Lipitor commercial featuring Dr. Robert Jarvik:

Pfizer was forced to pull these adds over controversy that they imply that Dr. Robert Jarvik treats patients, where he is actually an inventor and entrepreneur who has developed an artificial heart. This is an example of blurring reality to create effective direct to consumer advertising, and this is not the only example. Viagra adds were pulled in 2004 for implying that Viagra increased libido. When the AAMC limits the marketing of drug products or medical devices to physicians the alternative is to market these products to patients. The Viagra and Lipitor examples may be extreme and in all fairness both are Pfizer drugs. But the impact of 30 and 60 second drug adds that have potentially devastating side effects that are rattled off and barely audible in these commercials seems like something that should be factored into any discussion of how physicians involve themselves in the marketing process. Taking positions that will lead to big pharma diverting marketing budgets from educating physicians about new drugs to creating slick commercials created by Madison Avenue firms will not help the ultimate goal of doctors, helping patients. A more useful report would have laid out guidelines for how private industry and medical schools interact and placed reasonable limits on giveaways to medical faculty, staff and students. I am just concerned that the tone of the report and it’s strong stance makes any and all private industry-physician interactions seem tawdry when in fact they are necessary. Physicians need easy access to new information on drugs and medical devices and private industry need an opportunity to create name recognition for their products. The drug and medical device companies can develop revolutionary products but if no one knows about them they are useless. Private industry understands this and will market their products regardless of reports by the AAMC. As a document to prevent all perceived conflicts of interest the AAMC report hits the mark. But it’s necessary to view these issues with a global focus and the ultimate goal of creating a better health care system, which I’m not convinced this report will do.

With the SavvyDocblog, we not only want to highlight what we’re doing as a company, we also want to highlight other business, mainly start-ups that have disruptive business models aiming to make the health space better for ordinary people. Today, it was announced that Health Plan One raised $6.5 million Series A funding to build out their health insurance comparison site, led by Pequot Ventures.

Health Plan One is aiming to be the Orbitz or Travelocity of health insurance, that aims to bring transparency to the entire process, as well as ease of use. I think this idea has a great deal of merit because instead of pricing out the three companies that come to your mind when you think of health insurance, their service can streamline that search and compare sites side by side with one search. These comparison sites have really transformed the airline industry, and I expect a couple of sites similar to Health Plan One to pop up furthering innovation and disruption in this space.

How does this relate to SavvyDoc? What we aim to do is provide transparency within the health space, by enabling the consumer to have more choice and make more informed health care decisions. Although I cannot vouch for the accuracy of Health Plan One, from a mission statement and from a thirty thousand foot view, I like the idea.

Recovering from a little Spring flu but of course we have still been keeping up with some of the most interesting stories regarding the intersection of health care and technology. I want to briefly recap some previous posts with updated information.

We discussed the primary care crisis and the interesting solution of creating a doctor of nursing practice degree to fill the void of primary care physicians. I still think this is a reasonable idea if managed in the correct way so that medical doctors are still readily available for consultation when more complicated patients require care. My biggest issue with the DNP was that as a M.D. doctor it would be ideal if there were a better title for the DNP so as not to cause patient confusion. To update there was an interesting blog on pharmacists increasing their role in primary care. Having worked with an excellent pharmD in the past, I think this is a great idea. A pharmacist can be a great resource for patients when it comes to questions about medications and I argue could manage small medication adjustments just as well as physicians. The additional advantage comes in that actively involved pharmacists would be better equipped to help prevent medication errors.

There was a recent breach at the NIH where patient records were stolen from a doctor’s laptop. I argued that though these crimes of health care related information are serious they tend to be used as an excuse for not implementing electronic medical records (EMR) or other web based health care tools. My argument against limiting implementation of EMR’s is based on my experiences of paper based records being the least secure method conceivable for maintaining patient privacy. Having worked in a hospital with EMR’s and one without, the loose paper trail and privacy breaches when EMR’s are not implemented are atrocious. A colleague of mine brought up a great point one time, when a patient is hospitalized no less than 50 people are aware. This includes the doctors, nurses, phlebotomists, radiology techs, transporters, cleaning staff etc. To think a hospitalization is a private experience is a expectation based purely in fantasy. Using EMR’s will at least create a way for hospitals to monitor who is viewing records and make sure those records are only being viewed when necessary. This is how UCLA has been able to track down the staff members involved in the recent breeches of celebrity patients. Another point I made in this post was that medical information has little to no street value, this is compared to social security numbers and bank account information. Well, here is the evidence for that position. A patient admissions rep at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York sold 2,000 patient records for a whopping $1350. That’s less than 68 cents per record. Again, these security issues are important but considering a large percentage of us just recently e-filed are taxes and are awaiting our refunds to be direct deposited, which required providing our government a social security number and bank account number, these security issues should not continue to be used to prevent the progress in web based health care technology that will lead to more efficient and improved patient outcomes.

This was simply an introduction to what we are looking to accomplish with SavvyDoc. Through my experiences I have seen how difficult it can be for patients to obtain access to a quality physician or dentist. We are also aware that it is expensive and difficult for doctors to create a strong presence on the Internet. SavvyDoc is looking to be a simple and inexpensive alternative for both doctors and patients. This recent NY Times article on plastic surgeons and examining the expense of marketing cosmetic practices illustrates a lot of the pain we are alleviating with SavvyDoc. This article touches on the expense of obtaining and maintaining a website that is search engine optimized as well as the expense of being listed in a doctor search engine. Many doctors cannot justify these expenses but understand that they should have virtual access to their patients. SavvyDoc will provide an easy to use tool that puts doctor’s in control of how they are marketed and how patients find their doctor’s information on the web.